Containing COVID‐19 in the Emergency Department: The Role of Improved Case Detection and Segregation of Suspect Cases

Abstract

Objectives: Patients with COVID-19 may present with respiratory syndromes indistinguishable from common viruses. This poses a challenge for early detection during triage in the emergency department (ED). Over a 3month period, our ED aimed to minimize nosocomial transmission by using broader suspect case criteria for better detection and using appropriate personal protective equipment (PPE) for health care workers (HCWs).Methods: All ED admissions with respiratory syndromes over a 3-month period were tested for COVID-19. The sensitivity and specificity of screening criteria in detecting COVID-19 were assessed. A risk-stratified approach was adopted for PPE usage in the ED, based on high-risk "fever areas" and lower-risk zones. When a case of COVID-19 was confirmed, surveillance was conducted for potentially exposed patients and HCWs.Results: A total of 1,841 cases presenting with respiratory syndromes required admission over the study period.Among these, 70 cases of COVID-19 were subsequently confirmed. The majority (84.2%, 59/70) were detected at ED triage because they fulfilled suspect case criteria. Of these, 34 met the official screening criteria; an additional 25 were detected by the broader internal screening criteria. Over the 12-week period, the cumulative sensitivity of internal screening criteria was 84.3% (95% confidence interval [CI] = 73.6% to 91.9%), whereas the sensitivity of the official screening criteria was 48.6% (95% CI = 36.4% to 60.8%). Given the broadened internal criteria, the preexisting ED "fever area" was insufficient and had to be expanded. However, there were no cases of nosocomial transmission from intra-ED exposure, despite extensive surveillance.Conclusion: Frontline physicians need to be given leeway to decide on the disposition of cases based on clinical suspicion during an ongoing outbreak of COVID-19. If a broader criterion is used at ED triage, ED facilities and isolation facilities need to be readied to accommodate a surge of suspect cases. Usage of appropriate PPE is essential in minimizing nosocomial transmission.

Outpatient Otolaryngology in the Era of COVID‐19: A Data‐Driven Analysis of Practice Patterns

“…12,13 This is true among frontline physicians and departments, such as emergency rooms, as well as specialty providers, including otolaryngology. [14][15][16][17][18] Particularly pertinent to otolaryngology is a heightened concern regarding the increased risk of COVID-19 transmission owing to the nature of the head and neck examination and common otolaryngologic procedures. 7,8 Furthermore, telehealth and distance care can be especially difficult among subsets of otolaryngology diseases, including head and neck cancers and airway disorders.…”

Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: The experience of a tertiary-care hospital in Singapore

“…In general, the official suspect case criteria from our local Ministry of Health comprised a compatible clinical syndrome (pneumonia or acute respiratory disease of varying severity), together with a history of travel to high-risk countries affected by COVID-19, and/or epidemiologic risk factors (eg, contact with a confirmed case of COVID-19). 17 Our institution employed a broader set of internal screening criteria in our triage process in the emergency department (ED) to identify and isolate suspected COVID-19 cases early, with a cumulative sensitivity of 84.3% over the first 3 months of the outbreak. 17 However, given the presence of ongoing local transmission, we recognized that patients presenting with respiratory syndromes, but without any suspicious travel history or epidemiology links, might still have unsuspected COVID-19.…”

“…17 Our institution employed a broader set of internal screening criteria in our triage process in the emergency department (ED) to identify and isolate suspected COVID-19 cases early, with a cumulative sensitivity of 84.3% over the first 3 months of the outbreak. 17 However, given the presence of ongoing local transmission, we recognized that patients presenting with respiratory syndromes, but without any suspicious travel history or epidemiology links, might still have unsuspected COVID-19. Hence, all admissions with concomitant respiratory syndromes, without a travel history in the past 14 days or epidemiologic risk factors, were first admitted to the RSWs where COVID-19 was ruled out.…”

Risikostratifizierung von Notfällen während der COVID-19-Pandemie in der Zentralen Notaufnahme

“…Ein gleicher Ansatz findet sich auch in den Arbeiten von Wee Le et al. [ 22 ] aus Singapur. Hier konnte gezeigt werden, dass die zusätzlichen Falldefinitionen zu einer Steigerung der Sensitivität von 49 auf 84 % in der Identifikation von COVID-19-Fällen geführt hat.…”